Vein Graft Use and Long-Term Survival Following Coronary Bypass Grafting,Journal of the American College of Cardiology

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Vein Graft Use and Long-Term Survival Following Coronary Bypass Grafting
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2023-02-20 , DOI: 10.1016/j.jacc.2022.11.054
Emily Shih ₁ , John J Squiers ₂ , Jasjit K Banwait ₃ , Michael J Mack ₄ , Mario Gaudino ₅ , William H Ryan ₆ , J Michael DiMaio ₄ , Justin M Schaffer ₆

Affiliation

Background

Although placement of at least 1 arterial graft during coronary artery bypass grafting (CABG) has a proven survival benefit, it is unknown what degree of revascularization with saphenous vein grafting (SVG) is associated with improved survival.

Objectives

The authors sought to determine whether undergoing surgery performed by a surgeon who is liberal with vein graft utilization is associated with improved survival in patients undergoing single arterial graft CABG (SAG-CABG).

Methods

This was a retrospective, observational study of SAG-CABG performed in Medicare beneficiaries from 2001 to 2015. Surgeons were stratified by number of SVG utilized per SAG-CABG into conservative (≥1 SD below mean), average (within 1 SD of mean), and liberal (≥1 SD above mean). Long-term survival was estimated using Kaplan-Meier analysis and compared among surgeon groups before and after augmented inverse-probability weighting.

Results

There were 1,028,264 Medicare beneficiaries undergoing SAG-CABG from 2001 to 2015 (mean age 72.0 ± 7.9 years, 68.3% male). Over time, 1-vein and 2-vein SAG-CABG utilization increased, whereas 3-vein and ≥4-vein SAG-CABG utilization decreased (P < 0.001). Surgeons who were conservative vein graft users performed a mean 1.7 ± 0.2 vein grafts per SAG-CABG, whereas those who were liberal vein graft users performed a mean 2.9 ± 0.2 vein grafts per SAG-CABG. Weighted analysis demonstrated no difference in median survival among patients undergoing SAG-CABG by liberal vs conservative vein graft users (adjusted median survival difference 27 days).

Conclusions

Among Medicare beneficiaries undergoing SAG-CABG, there is no association between surgeon proclivity for vein graft utilization and long-term survival, suggesting that a conservative approach to vein graft utilization is reasonable.

中文翻译：

冠状动脉旁路移植术后静脉移植物的使用和长期生存

背景

尽管在冠状动脉旁路移植术 (CABG) 期间放置至少 1 个动脉移植物已被证明具有生存益处，但尚不清楚隐静脉移植术 (SVG) 的血运重建程度与改善的生存率相关。

目标

作者试图确定由自由使用静脉移植物的外科医生进行的手术是否与接受单动脉移植物 CABG (SAG-CABG) 的患者的生存率提高有关。

方法

这是一项关于 2001 年至 2015 年在医疗保险受益人中进行的 SAG-CABG 的回顾性观察性研究。外科医生根据每次 SAG-CABG 使用的 SVG 数量分为保守型（平均值低于 1 个标准差）、平均型（平均值的 1 个标准差以内） , 和 liberal（高于平均值 ≥1 SD）。使用 Kaplan-Meier 分析估计长期生存率，并在增强逆概率加权前后比较外科医生组。

结果

2001 年至 2015 年，共有 1,028,264 名医疗保险受益人接受了 SAG-CABG（平均年龄 72.0 ± 7.9 岁，68.3% 为男性）。随着时间的推移，1 静脉和 2 静脉 SAG-CABG 利用率增加，而 3 静脉和≥4 静脉 SAG-CABG 利用率下降（P < 0.001）。使用保守静脉移植物的外科医生每次 SAG-CABG 平均进行 1.7 ± 0.2 次静脉移植，而使用自由静脉移植物的外科医生每次进行 SAG-CABG 平均进行 2.9 ± 0.2 次静脉移植。加权分析表明，接受 SAG-CABG 的自由静脉移植患者与保守静脉移植患者的中位生存期没有差异（调整后的中位生存期差异为 27 天）。